Blue Cross & Blue Shield of Central New York, Inc. v. McCall

166 Misc. 2d 168, 632 N.Y.S.2d 449, 1995 N.Y. Misc. LEXIS 445
CourtNew York Supreme Court
DecidedSeptember 19, 1995
StatusPublished
Cited by1 cases

This text of 166 Misc. 2d 168 (Blue Cross & Blue Shield of Central New York, Inc. v. McCall) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blue Cross & Blue Shield of Central New York, Inc. v. McCall, 166 Misc. 2d 168, 632 N.Y.S.2d 449, 1995 N.Y. Misc. LEXIS 445 (N.Y. Super. Ct. 1995).

Opinion

OPINION OF THE COURT

Joseph C. Teresi, J.

Plaintiffs move this court for summary judgment declaring the provisions of the 1993-1994 and 1994-1995 State Operations Budget Bills which granted the Comptroller of the State of New York the authority to conduct audits of the plaintiffs pursuant to section 4308 of the Insurance Law to be unconstitutional. Defendants oppose this motion and seek an order sustaining the constitutionality of the Comptroller’s auditing power and seeking compliance by plaintiffs with subpoenas issued by defendant. Plaintiffs oppose the cross motion.

The crux of plaintiffs’ argument is that the subject provisions of the budget bills are unconstitutional because the New York Constitution prohibits the Legislature from granting authority to the Comptroller to do audits of a private corporation. Plaintiffs allege violations of NY Constitution, article V, § 1 and article III, § 1.

[170]*170At issue is the 1993 State Operations Budget Bill (L 1993, ch 50) which states: "Notwithstanding any law to the contrary, the comptroller may at his discretion conduct any or all management and/or financial audits permitted or required by article 43 of the insurance law.”

The 1994 State Operations Budget Bill (L 1994, ch 50) also allocated $1.2 million stating: "For sub-allocation to the department of audit and control for services and expenses of conducting any management and/or financial audits required by article 43 of the insurance law.”

Lastly, chapter 60, § 11 of the Laws of 1994 stated: "(3) for the department of audit and control for services and expenses of conducting any management and/or financial audits required by article 43 of the insurance law shall not be expended until the superintendent of insurance and the state comptroller agree to a plan as to the use of these funds, provided that the comptroller may at his discretion conduct any or all management and/or financial audits permitted or required by article 43 of the insurance law”.

Insurance Law § 4308 (d), (e) cited to both bills as the parameters of audits conducted either permitted or required states:

"(d) The superintendent shall order an independent management and financial audit of corporations subject to the provisions of this article with a combined premium volume exceeding two billion dollars annually in order to develop a detailed understanding of such corporation’s financial status and to determine the viability of such corporation’s products. Such audit shall be performed by an organization upon submission of a program plan in response to a request for proposal approved by the superintendent in consultation with the commissioner of health and the state comptroller. Such audit shall not be performed by any organization that has in any way performed or furnished services of any kind to the corporation within the past five years, unless it is adequately demonstrated that such services would not compromise that organization’s performance and objectivity. The audit shall be completed and a report submitted by May first, nineteen hundred ninety-three to the superintendent, the commissioner of health, and the chairs of the senate and assembly committees on health and insurance. The scope of the audit shall include, but not be limited to, financial and competitive position, corporate structure and governance, organization and management, strategic direction, rate adequacy, and the regulatory and competí[171]*171tive environment in the state of New York. Specifically, the audit shall include, but not be limited to:

"(i) determining the corporation’s financial and market position, including its reserves, trends in membership, market share, and profitability by market segment;

"(ii) evaluating the corporation’s product offerings with respect to market requirements and trends, the corporation’s responses to the New York health care market, and its management of medical claims costs;

"(in) assessing the effectiveness of the organizational and management structure and performance, including, but not limited to, possible improvement in the size, structure, composition and operation of the board of directors, productivity improvement, information systems, management development, personal practices, mix and level of skills, personnel turnover, investment practices and rate of return upon investment activities;

"(iv) analyzing the corporation’s strategic directions, its adequacy to meet competitive, market, and existing regulatory trends, including an evaluation of the use of brokers in marketing products, and the impact of those strategies on the corporation’s future financial performance and on the health care system of New York;

"(v) evaluating the adequacy of rates for existing products, particularly (but not limited to) small group, medicare supplemental, and direct payment to identify areas that may need immediate remedial attention;

"(vi) identifying any changes to the regulatory and legislative environment that may need to be made to ensure that the corporation can continue to be financially viable and competitive;

"(vii) identifying and assessing specific transactions such as the procurement of reinsurance, sale of real property and the sale of future investment income to improve the financial condition of the corporation; and

"(viii) evaluating and identifying possible improvements in the corporation’s managed care strategies, operations and claims handling.

"(e) Notwithstanding any other provision of law, the superintendent shall have the power to require independent management and financial audits of corporations subject to the provisions of this article whenever in the judgment of the superintendent, losses sustained by a corporation jeopardize its [172]*172ability to provide meaningful coverage at affordable rates or when such audit would be necessary to protect the interests of subscribers. The audit shall include, but not be limited to an investigation of corporation’s provision of benefits to senior citizens, individual and family, and small group and small business subscribers in relation to the needs of those subscribers. The audit shall also include an evaluation of the efficiency of the corporation’s management, particularly with respect to lines of business which are experiencing losses. In every case in which the superintendent chooses to require an audit provided for this subsection, the superintendent shall have the authority to select the auditor. Any costs incurred as a result of the operation of this subsection shall be assessed on all domestic insurers in the same manner as provided for in section three hundred thirty-two of this chapter.”

Initially this court notes that the appropriate standard of review as stated in Pharmaceutical Mfrs. Assn. v Whalen (54 NY2d 486, 493-494) is that: "Moreover, every legislative enactment enjoys a strong presumption of constitutionality which, although rebuttable, requires the challenging party to demonstrate that the enactment is unconstitutional beyond a reasonable doubt. (See, e.g., Robert E. Kurzius, Inc. v Incorporated Vil. of Upper Brookville, 51 NY2d 338, 344; Town of Huntington v Park Shore County Day Camp of Dix Hills, 47 NY2d 61, 65; Montgomery v Daniels, supra.)”

The main issue before this court is whether the Comptroller has the constitutional authority to conduct audits of the plaintiffs.

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Related

Blue Cross & Blue Shield of Central New York, Inc. v. McCall
218 A.D.2d 140 (Appellate Division of the Supreme Court of New York, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
166 Misc. 2d 168, 632 N.Y.S.2d 449, 1995 N.Y. Misc. LEXIS 445, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blue-cross-blue-shield-of-central-new-york-inc-v-mccall-nysupct-1995.